[Occlusive urethral systems: can they constitute an alternative in the management of female stress incontinence?]. / Sistemas oclusivos uretrales: pueden constituir una alternativa en el manejo de la incontinencia urinaria femenina de esfuerzo?

OBJECTIVE: To determine the utility of the urethral plug in the management of female stress urinary incontinence. METHODS: A prospective clinical study was conducted in 20 female patients with stress urinary incontinence in order to evaluate the efficacy of a new urethral plug. The mean age was 59.6 +/- 6.2 years (range 40-66). The study design included 3 visits (4 weeks). The results were considered "positive" when urinary incontinence decreased and the patient referred a subjective sensation of improvement, and "negative" if otherwise. RESULTS: Positive results were demonstrated in 8 patients (40%). Ten patients (50%) refused to continue, mainly due to urinary tract infection in 7 cases (35%), difficulties in plug use (loss of plugs, anomalous urethral anatomy, cystocele,...) in 6 cases (30%) and urethral mucosa irritation in one case (5%). No plug migrated into the bladder. The initial urinary incontinence grade in the positive cases were: minor in 4 (50%), mild in 2 (25%) and severe in 2 (25%). We found no statistical relationship between the urinary incontinence grade and clinical results. The patients used a median of 5 plugs per day. Of the 10 patients who completed the study, 5 (50%) refused to continue using the plug and 5 (50%) decided to continue using the plug in combination with electrostimulation and/or pelvic floor exercises. CONCLUSIONS: The use of the urethral plug in the management of female stress urinary incontinence is not an alternative to surgical treatment or pelvic floor rehabilitation. However, it could be useful for patients who are unwilling or unfit for surgery. Finally, the urethral plug is an alternative to the use of collecting systems or devices in female stress urinary incontinence.

Successful conservative management of emphysematous pyelonephritis, bilateral or in a solitary kidney.

Emphysematous pyelonephritis, bilateral or in a solitary kidney, is a life-threatening condition that requires prompt diagnosis and early intervention. Reported mortality is high, despite desperate surgical measures often ending in loss of renal unit, but medical management, possibly combined with percutaneous drainage, is sometimes successful. We report two cases of emphysematous pyelonephritis, one bilateral and one in a solitary kidney, with successful conservative management. Predisposing factors were insulin-dependent diabetes mellitus and micronodular cirrhosis secondary to chronic alcoholism. Prompt sonographic diagnosis determined the success of conservative management. Escherichia coli was identified as causal factor. In the bilateral case the clinical picture improved within 48 h after control of diabetes and broad-spectrum antibiotic treatment. For the affected solitary kidney, percutaneous drainage and ureteric catheterization were required.

[Upper urinary tract and urethral tumors in patients with bladder carcinoma]. / Tumores de tracto urinario superior y uretra en pacientes con carcinoma de vejiga.

OBJECTIVE: A clinicopathological study was conducted in patients with urothelial tumor of the bladder and urothelial neoplasm of the upper urinary tract or urethra to analyze the histological features, time interval between diagnoses and prognosis of these associated lesions. METHODS: 338 patients were reviewed retrospectively. A descriptive study was performed, including tables on the associated lesions and survival data. RESULTS: 21 cases (6.2%) had two urothelial tumors: carcinoma of the bladder associated with tumor of the upper urinary tract (14 cases) or urethra (7 cases). There is a longer time interval between diagnoses when the extravesical tumor is diagnosed after than when it is diagnosed before the bladder tumor (p < .05). A correlation between the grade, but not stage, of the extravescial and bladder tumors has been observed. We found no statistically significant differences for survival in patients with two tumors or with bladder cancer alone. Although not statistically significant, patients with metachronous extravescial tumor have a better prognosis than those with synchronous extravesical tumor. CONCLUSION: Patients with bladder cancer should be followed for years and screened for extravesical urothelial tumor. The foregoing associated lesion, especially the metachronous extravesical lesion, apparently does not make the prognosis worse.

[Secondary neoplasm in patients with bladder carcinoma. A case-control study]. / Neoplasia secundaria en pacientes con carcinoma de vejiga. Estudio caso-control.

Presentation of a case-control study on 755 subjects with the purpose of defining whether the development of a neoplasia on any organ and of any histological type, either synchronous or metachronous, occurs more frequently in patients who already have vesical carcinoma (338 cases) versus other populations of similar epidemiological characteristics comprising subjects who do not present that condition (417 controls). The evaluation of the difference between both groups establishes a cause-effect relationship expressed in terms of an odds ratio of 2:11 which allows to claim that presence of a second neoplasia is more frequent in patients with vesical carcinoma (p < 0.001). The paper also includes a discussion on the distribution to organs and systems. Once the cases with urothelial site (renal pelvis, ureter or urethra) are excluded, prostate adenocarcinoma is the most frequent form associated to vesical carcinoma, followed at a distance by renal adenocarcinoma, epidermoid carcinoma of the larynx and bronchopulmonary carcinoma. Cumulative incidence of secondary neoplasias, including tumours diagnosed synchronically is 12% at 54 months.

[Spontaneous perinephric hematoma in a case of AIDS]. / Hematoma perinéfrico espontáneo en un caso de SIDA.

OBJECTIVE: To review the wide spectrum of urological manifestations in the HIV-infected population. METHODS: We report a case of spontaneous perinephric hematoma (non-traumatic) in a young male drug user with HIV infection. The patient was submitted to emergency nephrectomy after acute bleeding secondary to a subcapsular hematoma. He had no previous history of trauma. RESULTS: No underlying disorder was found and it is not known if the association with HIV infection is merely casual or not. This is an uncommon condition that is usually secondary to benign or malignant renal tumors, vascular anomalies and inflammatory disorder. In some cases, however, the underlying cause is never found. CONCLUSION: It must be emphasized that HIV-infected patients may consult for diverse urological disorders whose differential diagnosis may be difficult to establish.

[Synchronous bilateral renal oncocytoma]. / Oncocitoma renal bilateral sincrónico.

OBJECTIVES: The present study reports a case of bilateral synchronous renal oncocytoma and reviews similar cases described in the literature. METHODS: The present case was incidentally discovered in an 81-year-old female during evaluation for GI disease. The arteriogram was suggestive of oncocytoma and was confirmed by aspiration biopsy. The patient refused surgery. At 42 months' follow-up, the size and degree of invasion of both tumors remain unchanged. To our knowledge, only 20 cases of bilateral synchronous oncocytoma have been reported in the literature and only 6 of these were multifocal lesions. RESULTS: Renal oncocytoma, like salivary gland lesions, may spread as an advanced stage multifocal nodular oncocytic hyperplasia. Therefore it is not surprising to detect multiple synchronous or metachronous oncocytomas. CONCLUSIONS: Bilateral renal masses are a diagnostic and therapeutic difficulty, and even more so in the absence of systemic manifestations, hereditary disorders or a family history of renal tumor.

[Malacoplakia of the prostate and seminal vesicle. Ultrastructural study and review of the literature]. / Malacoplakia de la próstata y vesícula seminal. Estudio ultraestructural y revisión de la literatura.

OBJECTIVES: The present study describes a case of malacoplakia of the genitourinary tract arising in the seminal vesicle and prostate and reviews similar cases previously reported in the literature. METHOD: A 67-year-old male consulted for hemospermia and voiding symptoms. Prostatic neoplasm was suspected on the basis of the clinical and radiological findings. RESULTS: The diagnosis was made only after biopsy and histological analysis. Electron microscopy is a very useful tool. Long-term antibiotic therapy may achieve optimal results. Treatment with fluoroquinolones was successful. CONCLUSION: To avoid unwarranted radical approaches, we underscore the possibility that prostatic pseudotumors may be misinterpreted as neoplasia. Malacoplakia is diagnosed only by histology and requires medical treatment.

[Obstruction of the lower urinary tract: contractile capacity of the detrusor and obstruction degree. Analysis of pressure/flow curves]. / Obstrucción del tracto urinario inferior: capacidad contráctil del detrusor y grado de obstrucción. Análisis de las curvas de presión/flujo.

OBJECTIVES: This study attempts to optimize information from pressure/flow curves of patients with obstructive symptoms. METHODS: We performed a computerized analysis of the pressure/flow ratio of 50 consecutive patients with benign prostatic hyperplasia and irritative and obstructive symptoms. All patients were evaluated urodynamically. This model (pressure/flow diagram) will allow application of this test (expressed as flow and pressure measurements) to urethral outflow resistance and detrusor power or energy. Outflow obstruction is classified into seven categories (O-VI) and detrusor contractility in four (very weak, weak, normal and strong). RESULTS: The suitability of urodynamic analysis was demonstrated. Those cases considered as indeterminate by the conventional method can be obviated by computerized analysis. The degree of obstruction and the contractile capacity were determined in these cases. CONCLUSIONS: This method provides more accurate information on pathophysiology of voiding, allowing for better diagnosis of outflow obstruction or poor detrusor contractility and avoids the diagnosis of "undetermined".

[Staging error in bladder carcinoma: anatomo-clinical correlation]. / Error de estadiaje en el carcinoma vesical: correlación anatomo-clínica.

Presentation of clinico-pathological correlation in a series of patients with bladder carcinoma. All of them had a complete pathological and clinical staging following TNM guidelines (UICC 1987). Clinical evaluation consisted of a clinical examination, urography and/or ultrasound, cystoscopy, bimanual palpation under anaesthesia and biopsy. As an option, pelvic CAT, MRI and a bone scan were performed. In all cases a reliable pathological staging was obtained, either from cystectomy or complete TUR. Overall, there is a 66% clinico-pathological correlation (60% for Ta category, 78% for T1, 25% for T2, 57% for T3, and 74% for T4). There is a global error of 34% (40% of cases clinically considered Ta were invasive, 16% T1 were pT2 or more, 42% T2 were pT3 or more, and 10% T3 were pT4; while 6% of those considered T1 were pTa, 33% of T2 were pTa or pT1, 33% of T3 were pT2 or less, and 26% of T4 were pT3 or less). We therefore conclude that when T is lower the risk of being clinically understaged is greater, while higher T values increase the risk of clinical overstaging. From a practical point of view, the most severe errors are in the understaging of T2 and T3 (pT3-pT4) tumours and the overstaging of T2 (pT1) tumours. When cystectomy is performed, the risk of understaging is greater for tumours interpreted as T2-T3 while the risk of overstaging T4 tumours is lower. We conclude that, even when adequate staging of bladder cancer is attempted, pre-treatment tumour classification using the diagnostic methods currently available is far from satisfactory.

[Radical prostatectomy: usefulness of selective electromyography of the periurethral sphincter in the assessment of urinary continence]. / Prostatectomía radical: utilidad de la electromiografía selectiva del esfínter periuretral en la valoración de la continencia urinaria.

The exact mechanisms of urinary continence in patients submitted to radical prostatectomy remain unknown. The aim of our study was to evaluate these mechanisms of continence through a complete urodynamic study, with a special emphasis on selective electromyography of the periurethral aphincter. Of a total of 10 consecutive patients who underwent radical prostatectomy between 1990-1993, a complete clinical control of urinary continence was demonstrated in 7 patients. The complete urodynamic work-up and particularly selective electromyography of the periurethral sphincter permitted evaluating the distal sphincteric mechanism and the degree of functional capacity. All of the cases showed loss of motor units, diminished electromyographic sphincter activity and incomplete lesion of the inferior motor neuron. The present study analyzed the pathophysiological, clinical and urodynamic aspects of these patients.

[Study, treatment and follow-up of 379 patients with urinary tract lithiasis]. / Estudio, tratamiento y seguimiento de 379 pacientes con litiasis del aparato urinario.

Between May 1988 and December 1989, 369 patients were seen at our lithiasis unit. During that time the Unit had neither "percutaneous nephroscope" nor "ureterorenoscope". Twenty-three percent of the patients were not susceptible to therapy either due to spontaneous extrusion of their lithiasis or because it was not considered indicated. Of the remaining 77% (296 cases) 94.5% were referred for extracorporeal lithotrity with shock waves, of which 89.8 were monotherapy and 4.7% a combination with other strategies (medico-lithic, surgical, endoscopic extrusion). At the time of collecting the results, 216 patients had undergone some treatment. In those receiving shock waves, an EDAP piezoelectric lithotripter was used in 19.9% and a HM3-Dornier in 80% of the cases. Taking into consideration the overall resulted from last examination of each patient, 67% were free from lithiasic residues, 25% had residues under 4 mm, and 7.7% residues over 4 mm. 19.4% of the patients developed some kind of complication and 9 patients had to be admitted to hospital.

[Brucellar orchitis with abscess]. / Orquitis brucelosa abscesificada.

A clinical case of orchitis with brucellosis etiology is presented. Testicular symptomatology appeared from the beginning of the brucellosis's general clinical picture. It envolved painfully and increased the testicular size, with no mictional symptoms, expanding progressively in spite of specific brucellosis therapy given from the beginning, towards formation of an intratesticular abscess which required orchiectomy, a way of progression we have not found in the related literature. The main differential diagnosis must be done with tuberculosis orchitis. Since our country had the largest incidence of brucellosis in Europe, and it is possible that in many cases a orchiepididymarial condition can become apparent in the initial phases, this is an etiology that should be taken into account among specific orchiepididymitis.